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Pediatric foot and ankle trauma, particularly severe cases, can be difficult to treat. Treatment can take the form of hybrid fixation with a combination of pediatric and adult techniques. Many fractures can be managed non operatively or with percutaneous fixation. However, as children approach adulthood, they also require rigid fixation techniques. The cases presented here span a wide spectrum of ages and fracture types, and the invited panel has presented both usual and unusual approaches to treatment.